The American Diabetes Association recently released nutrition therapy recommendations for the management of diabetes. Published in Diabetes Care, the new statement provides a set of recommendations based on reviews of recent clinical investigations (Table 1). The statement calls for all adults diagnosed with diabetes to eat a variety of nutrient-dense foods in appropriately portioned sizes as part of an eating plan. These plans must take into account individual preferences, culture, religious beliefs, traditions, and metabolic goals. Nutrition Therapy Is Effective The American Diabetes Association recognizes that nutrition therapy is provided by a variety of health professionals, and published research shows that it is effective when delivered by various health professionals. Studies suggest that nutrition therapy produces A1C reductions similar or greater than what is expected with treatment with currently available pharmacologic treatments for diabetes. “Ideally, patients with diabetes should be referred to registered dietitians (RDs) for diabetes nutrition therapy or participate in diabetes self-management education (DSME) programs that include instruction on nutrition soon after their diagnosis,” says Alison Evert, MS, RD, CDE, who was part of the writing group that developed the position statement. The position statement from the American Diabetes Association highlights guidelines from the Academy of Nutrition and Dietetics that recommend several effective structural components when implementing medical nutrition therapy for adults with diabetes (Table 2). “An important goal of nutrition therapy includes collaborating with healthcare providers to develop individualized eating plans and to encourage people with diabetes to get the ongoing support they need to promote health behavior changes.” Individualizing Approaches The American Diabetes Association recommends that all people with diabetes make nutrition therapy a part...

In recent years, more pharmacologic agents and treatment options have become available to treat hyperglycemia in type 2 diabetes. With the influx of new therapies, it can sometimes be challenging for clinicians to integrate these new therapies into treatment regimens. New guidelines and position statements from well-respected organizations can assist clinicians, but these documents evolve over time based on new information. Download free patient education brochures from the Patient Education Center, developed by Harvard Medical School. Insulin Therapy Click here to download Diabetes: Goals for Good Health Click here to download Several years ago, the American Diabetes Association and the European Association for the Study of Diabetes convened a group that developed consensus recommendations for antihyperglycemic therapy in non-pregnant adults with type 2 diabetes. Since that time, more information on the benefits and risks of glycemic control has emerged. In addition, there is new evidence on the efficacy and safety of several new drug classes as well as the withdrawal and the restriction of others. Furthermore, experts are suggesting that greater attention be paid to moving toward approaches to care that are more individualized and patient-centered. New guidelines on the management of hyperglycemia have been published concurrently in the April 19, 2012 online editions of Diabetes Care and Diabetologia. “Guidelines are constantly in a state of evolution based on new information,” says Vivian A. Fonseca, MD. “This document reflects recent data and availability on multiple treatment options for a variety of patients. In addition, the American Diabetes Association updates its overall standards of care every January. These new guidelines take a more holistic approach, focusing on treating people as...

Diabetes and cancer are major causes of illness and death worldwide. The CDC has released a report showing that the prevalence of diabetes has increased to 25.8 million in America, or 8.3% of the national population. It’s estimated that 2.5 million of these individuals are survivors of breast cancer. Research has shown that diabetes increases the risk of breast cancer. Furthermore, two of the major risk factors for type 2 diabetes—older age and obesity—have also been associated with breast cancer. A concern for physicians managing patients who have diabetes and are diagnosed with breast cancer is that care for the preexisting diabetes often goes on the back burner; the breast cancer takes center stage. Patients may sometimes view their breast cancer diagnosis as a greater threat to their lives than their diabetes. Alarming Data on Breast Cancer-Diabetes Relationship In order to better understand the relationship between breast cancer and diabetes, my colleagues and I conducted a systematic review and meta-analysis of previous research. Published in the January 2011Journal of Clinical Oncology, our investigation looked in depth at eight studies involving patients with preexisting diabetes and breast cancer outcomes. Six of the studies reported a risk estimate effect on all-cause mortality in patients with breast cancer. We then qualitatively summarized other prognostic outcomes. When compared with those who did not have diabetes, women with breast cancer and preexisting diabetes had a 49% greater risk of death. “When compared with those who did not have diabetes, women with breast cancer and preexisting diabetes had a 49% greater risk of death.” Another important finding from our research was that three of four...

The American Diabetes Association held its 2010 Annual Scientific Sessions from June 25 to 29 in Orlando. The features below highlight some of the news emerging from the meeting. » Investigational Drug Effective as Metformin Add-On » Minor Kidney Damage in Type 1 Diabetes Increases Mortality » The Impact of Exercise Alone on Diabetes Risk » Omega-3 Fatty Acids, Women, & Type 1 Diabetes » Diabetes A Common Cause of Vascular Death Investigational Drug Effective as Metformin Add-On [back to top] The Particulars: Dapagliflozin is an investigational selective sodium-glucose cotransporter-2 inhibitor. Dapagliflozin is thought to reduce renal glucose reabsorption so that excess blood glucose is instead excreted into the urine. The mechanism of action is independent of insulin. A phase III trial was conducted in metformin patients who had not achieved adequate glucose control. Data Breakdown: All patients were randomized to placebo or one of three doses of dapagliflozin (2.5 mg, 5.0 mg, or 10.0 mg), and patients also continued taking metformin. Mean glycosylated hemoglobin decreased significantly for patients on any of the three doses of dapagliflozin when compared with those on placebo. At 24 weeks, more patients in the dapagliflozin groups achieved a therapeutic response, which was defined as A1C levels of less than 7% (33% to 40.6% in dapagliflozin groups vs 25.9% in controls). Decreases in fasting plasma glucose concentration and weight loss were also significantly greater in the dapagliflozin groups when compared with placebo. Take Home Pearls: Adding dapagliflozin to metformin may improve glycemic control in patients with diabetes who are not responsive to metformin monotherapy. The addition of dapagliflozin to metformin may provide a new...